Nutrition Care Plan

NTR 417
Tasha Gillette

NUTRITION CARE INFORMATION:

Alice currently has problems with eating due to her decreased eye sight and Parkinsons disease,
and this impacts her eating skills. She did report not eating out due to these present issues. Her
eating habits observed are quick, non-nutrient dense meals that are easy for her to eat without
cooking. She does have assistance with dinner when her family is there to help, but still is low in
many vitamins and minerals that she would get from fresh food. She doesnt have any current
food allergies that may impact consuming certain foods. She did report a 60 lb. weight loss in the
past two years due to increased symptoms of her multiple comorbidities. She also expressed
wanting to eat many foods that are not nutritionally dense, due to her current state and wanting to
enjoy these foods. She did report not receiving any nutrition counseling for her current disease
state.

SOCIAL HISTORY: Alice is a 77 year old white widowed female who lives with her daughter
in Sioux Falls, SD. She owns a two story home, but mainly resides on the first floor. Alice is
retired and her daughter and family provide for her. Alice and her family have adequate money
to provide for bills and their home, but did discuss not having an excessive amount. Alice is able
to stay at home during the day alone while her daughter works. She currently has no
consumption of alcohol or smoking tobacco but did use excessively in the past.

Nutritional Implications: Alice has a great support system and currently is able to provide
for herself during the day alone. Her home layout helps with being able to access
anything.

MEDICAL HISTORY: Alice has a history of type 2 Diabetes, osteopenia, COPD, Parkinsons
disease, pulmonary arterial hypertension, and dry molecular degeneration. Alice does have issues
with seeing things clearly and using her hands for activities. She is able to walk effectively
around her home and to and from places.

Nutritional Implications: Alices current medical problems affect her nutritional status.
She eats very slowly and expressed she never eats out in public. This results in her eating
very convenient foods that are not nutritionally dense. This can greatly affect her
hypertension status with increased sodium intake. Her COPD is greatly affected because
of her past history of smoking.

DIET HISTORY: Alice is currently on a regular diet with no restrictions. From her food diary
record, Alice consumes about 1700 calories a day. She reports have a good appetite and is
currently not experiencing any N/V/D/C. She does report not eating enough fruits and
vegetables.
 Nutritional Implications: Alice is not getting the essential vitamins and minerals. She is
under in Vitamins A, C, D, E, and K. She is also low in calcium, potassium, copper,
magnesium, selenium, and zinc. Since she is only able to consume very convenient foods
her diet reports being over in added sugars and fat.

MEDICATIONS:

Carbidopa- Levodopa (25-100 mg) anti-Parkinson treatment

Nutritional Implications- taken hour before meal. May cause decreased weight, nausea,
and vomiting.

Losartan/HCT (50 mg/12.5 mg) angiotensin 2 receptor antagonist (ARB) antihypertensive,

type 2 diabetic nephropathy treatment.

Nutritional Implications: This drug should be taken with food. Can cause dyspepsia,
abdominal pain, and diarrhea.

Metformin HCL (500 MG) anti-hyperglycemic agent that is taken for the type 2 diabetes
treatment.

Nutritional Implications: This drug should be taken with food and alcohol intake should
be avoided. Can cause headache, fatigue, and muscle pain.

Bumetanide (1 MG) diuretic, antihypertensive and is used to treat edema.

Nutritional Implications: This drug should be taken on an empty stomach, but may take
with food if GI distress occurs. Increased thirst may occur and diet modifications may be
needed.

PATHOPHYSIOLOGY:

Alices current problem consist of symptoms from her Parkinsons Disease. Parkinsons disease
is a progressive, disabling, and neurodegenerative disease (Mahan, 2017). It is this authors
opinion that there is currently no evidence to what may have caused Alices PD. Many
environmental factors have been tested e.g. dairy products, stress, smoking, and possibly drug-
induced PD. Alices current PD has not been established to what may have caused it.

Parkinsons disease is caused by damage to the nerve cells in the brain. The part of the brain that
is affected is the substantia nigra which has a vital role in releasing dopamine. Parkinsons
disease is most common in ages 40 and 70. With age the loss of neurons that contain dopamine
decrease as well and when metabolized dopamine can be toxins that result in cell death (Mahan,
2017).
The classic symptoms of Parkinsons disease include tremor at rest and rigidity. The best
therapies include physical therapy, pharmacotherapy agents, and surgery. The main focus with
nutrition therapy is to optimize intake and reduce any muscle mass loss that is used for strength
and mobility.

Nutrition related focus is to watch for any drug and nutrition reactions that may occur. The main
focus with Levodopa is intake with protein. With increased protein intake in the morning and
with lunch dyskinesia may occur. Dyskinesia is the impairment of voluntary movement, which is
a classic symptom with Parkinsons Disease. With the progression of this disease eating may
become difficult with not having the ability to hold their head up and tremors of hands to
consume and drink fluids. Dysphagia is a late complication but will need to be monitored so
aspiration does not occur.

ASSESSMENT:

Alice has multiple health related issues that impact her nutritional status. Her inability to eat
normally due to her tremors and dyskinesia are present and may cause malnutrition if not
monitored. Alice can currently do most household duties on her own, but this may diminish with
the progression of the disease.

Alice is currently overweight. Her weight recent weight loss of 60 lb. in two years indicates that
some weight loss has already occurred. Her weight being what it is now is good and there are
currently no signs of being malnourished.

Alices current estimated energy needs (based on Mifflin-St. Jeor requirements) are 1358.5
calories and estimated protein needs are 52 g based on 0.8 g/kg of BW. Alices current diet is
supplying more calories, on average 1700 calories and has adequate amount of protein. While
weight loss is not essential, gradually decreasing amount of calories consumed daily will help
with achieving a normal weight goal.

PES Statement is: Inadequate vitamin and mineral intake related to decreased ability to consume
nutrient-dense food as evidenced by 3-day food diary.

INTERVENTION:
Provide about 1400 kcals and 52 grams of protein per day to meet needs for Parkinsons disease.
Providing the patient with education on calorie and meal pattern goals to decrease symptoms of
the disease.

MONITORING & EVALUATION:

Short-term goals

1. PO intake to meet < of 20% to reach estimated calorie needs.

Long-term goals

1. Prevent malnutrition/aspiration in the future due to increased symptoms.

2. Weight goal to be in a normal range.
 REFERENCES

Mahan, K (2017). Krauses Food and Nutrition Care Process. (14th Ed.) St. Louis, Missouri,:
Elsevier Inc.

Pronsky, Z (2015). Food Medication Interactions. (18th Ed.) Birchrunville, PA.: Food-
Medication Interactions